Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
One of the best pieces of research with which I was involved was rejected by The BMJ when I was one of its medical editors. A qualitative study. it was exciting and innovative and it gave some remarkable insights into genetic medicine - or so I thought. I don’t know quite why it was rejected. Research submitted by members of the editorial team was assessed outside the normal process so I didn’t have access to the notes and it was never discussed with me. I published other studies in The BMJ both before and afterwards, but that paper was special and (many years afterwards) I still feel they made a mistake…but, every author thinks that, don’t they?!
Submitting a paper to a major general medical journal is a big deal. There used be a certain ceremony in sending off three doubled spaced typed copies in the mail and saying goodbye for a few weeks. Now, thanks to electronic manuscript submission, you can spend years doing the work, weeks preparing the manuscript, hours filling forms and uploading supplemental material, and be rejected within minutes.
One author wrote after receiving just such a quick decision that she was just not psychologically prepared for such rapid rejection. Submitting your work means exposing yourself and your research to external scrutiny and it can be quite stressful. So, for anyone whose paper I have rejected, please forgive me. However harsh the decision might feel, know that I do understand your disappointment. Your work may have been rejected by me or some other unknown editor, but I had my work rejected by my friends and colleagues.
Most journals aim for a rapid decision. In general, the longer a paper is with a journal the more likely that it has gone to peer review. If the editors are interested and the peer reviewers supportive, it may be discussed at a manuscript meeting. That, in itself, is quite an achievement as most papers are rejected much earlier. The process at CMAJ differs little from other major general medical journals - we usually discuss five or six papers with an editorial team group drawn from a range of specialties and including a statistician. Rejected authors are often upset when they read the decision yet find their paper has supportive external reviews. But, of course, every paper that makes it as far as a manuscript meeting has had supportive reviews- otherwise it would have been discarded earlier. The final decision is made taking these reviews into account but they do not determine the decision; that decision is made by the editors after detailed discussion. Editors try very hard to be fair but we all make mistakes. Authors sometimes complain that editors have not understood their work and, indeed, that may be the case - we are not as immersed in the topic as the research team. But, being so close to their subject, authors sometimes fail to adequately explain the importance of the research question. Remembering the CMAJ tagline, “Medical Knowledge that Matters”, authors need to explain why their research question is important and why their findings should matter to our general medical readership at this particular time.
Was there a happy ending? I still look back fondly on that rejected paper and it remains my benchmark for a quality qualitative paper. There is a home for every good paper and, of course, it was published elsewhere. It was a great research idea, a superb piece of work, and I played a very small part. All the credit should go to the first author, who was my first PhD student and who is now herself a professor.